Following Patients Home

No, I'm not talking about stalking people. Here in the NHS, it is common practice for therapists who have worked with a patient in the hospital to continue treating that person once he goes home. If you are a hospital-based therapist here, you may spend half of your day actually in the community. There are advantages and drawbacks to this way of working.

The advantages are continuity of care for the patient, exposure to working in the community for therapists, and decreased likelihood of information getting lost or distorted in the handover of care from one provider to another.

There are some disadvantages as well. If a ward is particularly busy, the patients already at home are a lower priority and may not get seen in a timely fashion. The hospital therapists are also part of "Foundation" Trusts, whereas most community services are "Primary Care" Trusts. What this means is that the hospital therapists may not know or have access to other necessary services in the community.

It is incredibly inefficient to have people leave a ward to provide services outside the hospital, particularly when there are teams in place to handle that workload. Lastly, I have seen cases where patients become dependent on the therapist. The very nature of staying with a patient for too long deprives the patient of growing more independent and autonomous.

It is a practice strongly embraced here and to question draws ire, particularly among occupational therapists. I don't think it is a tradition that works and in this time of NHS revision, should be abandoned.

3 comments

Good post with astute observations. I wonder if physiotherapists would have similar observations about US therapy? It is easy to do things the way they have always been done and fail to question whether "the way" is still effective.

Usually continuity of care is good. But at times it could be a drawback, especially where PTs following acute patients into the home is concerned.

I had the occasion to see the same patient in acute care and then in her home. It was like seeing two different people! A few months later when I evaluated a home health patient I was able to understand I was on the home health side of that transformation. Otherwise, I would have thought the discharging acute care PT needed to have her license revoked. She had documented the patient was max assist of three people. He went home on a Friday, I evaled him at home the following Monday. He was mod assist of one. A large man, tall and robust. The home environment truly can make that big of a difference.

Fortunately, both of those patients were motivated to improve. We've both been around enough to know that isn't always the case. So, if you have continuity of care combined with a patient who is dependent rather than motivated, it would be easy for them to not meet up to their potential.

Unfortunately, there are also therapists who aren't motivated. Continuity of care across settings puts patients at risk of continuing with a therapist who doesn't push them to their fullest potential because of a preconceived notion of what the patients' abilities were in the hospital.

Janey Goude

September 1, 2011 7:36 PM

Jason, good points. Regarding "if the patients are happy" just wait until next weeks post. Regarding "getting the care they need" just re-read what I say about patients in the community being a lower priority for hospital based physios vs top priority for community bases physios and what I didn't make clear, the whole MDT doesn't follow the patient home, just the physio. A patient may need nursing care, social work intervention or another service which has not followed the patient home. It really is too much of a disconnect for my satisfaction. Thanks for posting.

Dean Metz

August 31, 2011 3:57 PM

True, continuity of care would be a benefit. How long can the NHS support this practice? Seems inefficient use of therapy if the therapist does not know enough about community support processes. In the end, what is the patient satisfaction with this? If patients are happy and getting the care they need should it be changed?

Jason

August 30, 2011 10:54 PM

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